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This Week in JAMA
JAMA. 2003;290:9.
Sigmoidoscopy Results 3 Years After a Negative Exam
Current guidelines recommend that flexible sigmoidoscopy screening for colorectal cancer be repeated 5 years after a negative examination, but the optimal screening interval is uncertain. In this analysis of data from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a trial evaluating the effectiveness of cancer screening tests on site-specific cancer mortality, Schoen and colleagues (SEE ARTICLE) found that the incidence of adenoma or cancer in the distal colon 3 years after a negative examination was 3.1% and the incidence of advanced adenoma or cancer was 0.8%. In an editorial, Fletcher (SEE ARTICLE) discusses how frequently screening sigmoidoscopy should be repeated, whether sigmoidoscopy is effective enough relative to other available screening tests, and how to make sigmoidoscopy available to all adults who want to be screened.
Continuous Quality Improvement in CABG Surgery
Results of randomized trials testing the efficacy of continuous quality improvement have been inconsistent and have involved small numbers of study sites. Ferguson and colleagues conducted a national randomized trial at 309 sites to test whether a continuous quality improvement intervention that included a call to action from a physician leader, educational products, and periodic nationally benchmarked site-specific feedback would increase the use of 2 coronary artery bypass graft (CABG) surgery process-of-care measures: preoperative  -blockade therapy or internal mammary artery grafting in patients 75 years or older. Within 2 years, use of both process measures increased more at the intervention sites than at the control sites, although results were statistically significant only for use of -blockade.
(SEE ARTICLE)
Depression Therapy for Low-Income, Minority Women
Impoverished minority women are less likely to receive appropriate care for depression than white women. Miranda and colleagues conducted a randomized trial among low-income and minority women with depression to compare 2 guideline-based interventions—an antidepressant medication intervention and a cognitive behavioral therapy intervention—with referral to a community mental health service provider. After 6 months, improvements in depressive symptoms were significantly greater in the intervention groups than in the community referral group. Instrumental role and social functioning improved significantly in the medication intervention group, and social functioning improved significantly in the cognitive behavioral therapy group compared with the community referral group.
(SEE ARTICLE)
Obesity and Gastroesophageal Reflux Symptoms
Evidence on the relationship between body mass and gastroesophageal reflux symptoms are limited and inconsistent. In this analysis of data from 2 population-based public health surveys in Norway, Nilsson and colleagues found a dose-dependent association between increasing body mass index and reflux symptoms in both men and women. The association was significantly stronger among women, especially among premenopausal women and women who used postmenopausal hormone therapy.
(SEE ARTICLE)
Feeding Tube Use Among Nursing Home Residents
Use of feeding tubes among older persons with advanced dementia has not been shown to be beneficial and may be associated with increased risks and discomfort. In this cross-sectional study of adults with advanced cognitive impairment residing in Medicare- or Medicaid-certified US nursing homes, however, Mitchell and colleagues found that 34% had feeding tubes. Use of feeding tubes was independently associated with both residents' clinical characteristics and nursing homes' fiscal, organizational, and demographic features.
(SEE ARTICLE)
Medical News & Perspectives
The emergence of monkeypox in the United States is yet another reminder of the ease with which microbes can cross the globe and threaten human health.
(SEE ARTICLE)
Treatment of Diabetes and Heart Failure
Despite explicit warnings, use of metformin and thiazolidinediones among patients with both diabetes and heart failure is common and appears to be increasing.
(SEE ARTICLE)
Mortality After Smokers With CHD Quit Smoking
A systematic review of 20 articles indicates that quitting smoking is associated with significantly reduced risk of all-cause mortality among patients with coronary heart disease (CHD).
(SEE ARTICLE)
CLINICIAN'S CORNER
Prognostication in Advanced Cancer
Perspectives on Care at the Close of Life
The case of Ms M, an 83-year-old woman with advanced cancer whose physician substantially underestimated her survival, illustrates the complexities of predicting survival and disclosing prognostic information to the patient.
(SEE ARTICLE)
JAMA & Archives Online
The JAMA & Archives Journals Web sites have been redesigned and offer easier navigation, improved search and tracking functions, and online continuing medical education (CME).
http://pubs.ama-assn.org and http://jama.com
(SEE ARTICLE)
MSJAMA
Financial interests and the conduct of biomedical research.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about smoking and cardiovascular disease.
(SEE ARTICLE)
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